Healthcare Provider Details

I. General information

NPI: 1902775471
Provider Name (Legal Business Name): GRETA HUBER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2025
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 PALENCIA CLUB DR
ST AUGUSTINE FL
32095-6901
US

IV. Provider business mailing address

3033 PLUM ST
JACKSONVILLE FL
32205-5718
US

V. Phone/Fax

Practice location:
  • Phone: 360-674-6895
  • Fax:
Mailing address:
  • Phone: 360-674-6895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: